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From the 4/8/2021 release of VAERS data:

This is VAERS ID 64533

Case Details

VAERS ID: 64533 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-11-05
   Days after onset: 36
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 47 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC Split Type: 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;

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